Provider Demographics
NPI:1205913084
Name:SECURELINE, INC.
Entity type:Organization
Organization Name:SECURELINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DADYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-788-8558
Mailing Address - Street 1:5158 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1401
Mailing Address - Country:US
Mailing Address - Phone:818-788-8558
Mailing Address - Fax:818-788-8668
Practice Address - Street 1:5158 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1401
Practice Address - Country:US
Practice Address - Phone:818-788-8558
Practice Address - Fax:818-788-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03049FOtherMEDI-CAL
CA03049FOtherMEDI-CAL